The BDN Opinion section operates independently and does not set newsroom policies or contribute to reporting or editing articles elsewhere in the newspaper or on bangordailynews.com. Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Even as COVID has faded into the background for most of the public, our curiosity about the virus’s idiosyncrasies hasn’t waned. Why does one member of a household suffer a hacking cough but another not even a sniffle? Why does long COVID afflict some and not others? A cluster of new studies suggests some of the answers lie in our genes. What scientists are learning could help them develop better vaccines in the future — either for new variants of COVID-19 or entirely new forms of SARS. Mild cases or asymptomatic infections have been relatively unstudied. Scientists’ focus on the sickest patients wasn’t just because of the urgency to save lives, but because it’s simply easier to study people in a controlled setting like a hospital. Collecting DNA, sequencing it and then tracking healthy people out in the community is an impossibly tall order. A team of researchers, led by the University of California, San Francisco’s Jill Hollenbach, found a clever way of getting around that problem by tapping into a group of people who had already given up their DNA: bone marrow donors. The team invited donors to participate in an ongoing project at UCSF called the COVID-19 Citizen Science Study. Hollenbach’s team recruited nearly 30,000 volunteers to download an app and, when they eventually tested positive for the virus, complete a questionnaire about their symptoms. Although they’ve been collecting data from that cohort for years now, this study was limited to the time before people were vaccinated so the results could be cleanly interpreted, Hollenbach said. They were looking for differences in a group of genes called HLA (short for human leukocyte antigen) that carry the recipes for proteins that help our immune cells distinguish between our own biological detritus and unwelcome invaders. The proteins show little pieces of viruses to our T-cells, which take this as an invitation to attack. Because T-cells have a long memory, they swoop in again fast the next time a similar virus invades. The researchers found that people who carried one copy of a version of a gene called HLA-B*15:01 were more than twice as likely to remain asymptomatic after being infected with COVID. And people who inherited two copies of the gene (one from each parent) were eight times more likely to never suffer symptoms. Hollenbach’s team found that this particular flavor of HLA is very good at recognizing garden variety coronaviruses, and the T-cells exposed to those were later very good at detecting important bits of SARS-CoV-2. In other words, people with this variant who also had, say, a common cold “have this kind of superpower” of managing their COVID infection to the point where they don’t have symptoms, she explains. “I think their findings are very exciting,” said Jean-Laurent Casanova, a Rockefeller University scientist who studies the relationship between our genes and susceptibility to infectious diseases. “It suggests that T-cells are involved in the early phase of SARS-CoV-2 infection, and that a strong T-cell response can blunt infection and prevent clinical manifestations.” @media ( min-width: 300px ){.newspack_global_ad.block_64c05594055dc{min-height: 100px;}} Another study, yet to be peer reviewed, offers genetic ties to the other end of the spectrum: when people suffer lingering symptoms. Researchers compared about 6,500 people with a long COVID diagnosis to nearly a million people without. People were 1.6 times more likely to develop long COVID if they had a variant in a gene called FOXP4. That same gene is also known to be a culprit in lung cancer and severe COVID. While these studies help explain the wide range of responses to the virus, many questions remain unanswered. For example, why were some people not just asymptomatically infected, but never infected? Casanova is interested in, say, that “health care worker without a mask in 2020 that has repeatedly tested negative, negative, negative. They’re seemingly resistant to infection and we think there’s a genetic basis for that.” His lab is currently analyzing some 2,000 genomes among that group to try to fish out the gene responsible. Scientists would also like to understand if there are genes involved in other, rarer situations, like the people whose infections cause brain swelling, or others that get a form of heart inflammation called myocarditis after getting the mRNA vaccines. @media ( min-width: 300px ){.newspack_global_ad.block_64c0559418de4{min-height: 100px;}} Like all science, understanding the genetic link to susceptibility is just pulling on the first thread. So much other work needs to be done to unravel the rest. Hollenbach’s findings about asymptomatic COVID, for example, should prompt more exploration into alternate approaches to vaccination. The existing vaccines all try to prevent infection altogether, but there could be merit in focusing on vaccines designed to take advantage of that memory T-cell response that seems to work so well for people with the right genetics. “Maybe you get infected, but manage it so quickly and effectively that you don’t experience illness,” she said. It is important to keep unraveling these mysteries. They teach us about better ways to address this virus, which we know is here to stay, and also contribute to the broader understanding of how genes shape the immune response. More articles from the BDN
Day: July 4, 2024
Sepsis (Adobe Stock, unknown) A recent cost-consequence analysis in Critical Care Explorations has revealed that utilizing the IntelliSep Index (ISI) for early sepsis diagnosis in the emergency department (ED) is both more effective and less expensive in preventing mortality compared to procalcitonin. Christopher S. Hollenbeak, PhD, Department Head of Health Policy and Administration and Professor of Surgery and Public Health Sciences at Penn State University, answered questions from Infection Control Today® (ICT®) about the study. “Sepsis causes 270,000 deaths and costs $38 billion annually in the United States, “according to the authors of the study. “Most cases of sepsis present in the emergency department (ED), where rapid diagnosis remains challenging. The IntelliSep Index (ISI) is a novel diagnostic test that analyzes characteristics of WBC [white blood cell] structure and provides a reliable early signal for sepsis. This study performs a cost-consequence analysis of the ISI relative to procalcitonin for early sepsis diagnosis in the ED.” ICT: A summary of the key findings and why they are important. Christopher S. Hollenbeak, PhD, Department Head of Health Policy and Administration and Professor of Surgery and Public Health Sciences at Penn State University, (Photo courtesy of Cytovale) Christopher S. Hollenbeak, PhD: Our team performed a cost-consequence analysis to evaluate the health economics of using a new IntelliSep test to inform sepsis care in the ED. In this analysis, IntelliSep was compared to procalcitonin (PCT), a biomarker related to bacterial infection evaluated as a sepsis indicator and performed similarly to the standard of care. The study supported the hypothesis that using Intellisep as part of the sepsis diagnostic strategy may provide effective reductions in the clinical and financial burden of treating sepsis compared to a procalcitonin diagnostic strategy. The IntelliSep test could serve as an invaluable element of sepsis care by quickly and efficiently focusing care on those with the highest risk of sepsis while expediting the care of those with lower risk. ICT: What is the practical application of the key findings for infection preventionists from this study? CSH: The search for solutions and improvements in sepsis care has become increasingly complicated as the incidence of sepsis continues to rise due to increased awareness, changes in the population’s risk profile, such as increasing age and comorbidities, and the impact of the COVID-19 pandemic on pre-existing workforce shortages. Solutions that will safely reduce the cost of care without sacrificing outcomes will require addressing the many factors driving the soaring economic burden of the disease in this new, post-pandemic era of medicine. This study suggests that risk stratification informed by the IntelliSep test could improve survival for patients with sepsis as compared to that reported with PTC and do so with an expected cost of more than $800 less than that for PCT. This finding is important given that outcomes in sepsis have been proven dependent upon prompt recognition and action. ICT: What results surprised you, if any? CSH: One of the more surprising aspects of the study is that an IntelliSep-informed treatment process saves, on average, over $800 per patient tested while also providing a small mortality benefit. This indicates that the IntelliSep test may enable centers to decrease the economic burden of sepsis and achieve better clinical outcomes. And while the study design relies on many assumptions, it is a home run. ICT: What, if any, future research will there be related to this one CSH: Great question. This study approximates the health-economic outcomes of using the IntelliSep test to inform clinical care of potentially septic patients. The IntelliSep test recently received FDA Clearance. Applying the test in the care environment will offer another opportunity to capture clinical and financial outcome information and add additional information to this work. ICT: Is there anything else that you would like to add? CSH: In our evaluation, the IntelliSep test showed that using the test to inform sepsis care is clinically and economically superior to a strategy informed by PCT. This performance is encouraging, given that the test can be performed in under 10 minutes and utilizes whole blood from a standard EDTA draw. Given its performance and fit within hospital workflows, the trial represents a promising new development in managing sepsis patients.
This article summarizes an opinion piece in the Proceedings of the National Academy of Science. It explores the history and language of the “standard model” of infectious disease, SIR – Susceptible, Infectious, Recovered. Infectious – the Germ Theory In 1890 Robert Koch published his criteria for the causal relationship between microbes and disease, setting the stage for the germ theory of disease. The influence of this theory cannot be overestimated – it has explained our global life expectancy remaining stubbornly stuck at two to three decades. It allows us to act upon that information with “the advent of hygiene, vaccines, aseptic surgery, and antibiotics….” His first postulate states that a given pathogen is found in all patients with the corresponding disease and not in healthy individuals. But as herpes zoster and COVID clearly demonstrate, that is not true – many patients are host to the microorganism, but far fewer have clinical manifestations, “the corresponding disease.” Tuberculosis is another example of an “infection enigma.” Mycobacterium tuberculosis, the infectious agent of the continuing global problem of tuberculosis, is estimated to reside in 25% of the global population. Yet 90% of those individuals have a latent form, where the mycobacterium is present, it is not contagious, and the patient has no clinical manifestations. René Dubos, more than 70 years ago, recognized these “silent” infections must be due to “a recent causal “weakening” of the sick host, after infection, but before the development of disease.” Those weakenings, or as he described, “changing circumstances,” were attributable to external environmental stressors, “ecological” in the sense that the stress originated in the environment, which could also, in turn, be modified by the host. Vaccines, social distancing, and masks are all environmental modifications. Susceptibility Moving toward genetics Sickle cell anemia or sickle cell disease (SCD) is an inherited disorder, an abnormality in the hemoglobin molecule that reduces oxygen transport ability and causes clumping and clotting. The resultant clumps and clots obstruct blood flow in the smaller vessels and provoke extremely painful sickle cell crises damaging organs like the kidneys. In 1949 a South African geneticist, Anthony C. Allison, was faced with a puzzle. When the hemoglobin abnormality of SCD is found in both genes contributed by the parents, the disease is fatal. But he discovered that upwards to 20% of the Kenyans he assessed had the far less lethal trait, one, not two, abnormal genes. He reported in 1954 that the underlying reason for such a high percentage was that “sickle cell trait provides large African populations with 10-fold greater protection against the risk of cerebral malaria…[a] population level has never been surpassed by candidate gene or genome-wide approaches.” Several other notable examples of susceptibility to infections and our underlying genetics exist. Bacterial appendicitis is infectious but not contagious. There are familial clusters of appendicitis. Studies of tuberculosis in twins from the 30s and 40s show a more significant “sharing” of TB with genetically identical (monozygotic) twins at 90% than dizygotic twins, born with differing genetics, at 20% The 1980 HIV epidemic demonstrated how an acquired immunodeficiency could result in specific rare infections, like pneumocystis pneumonia (PCP), caused by the fungus Pneumocystis jirovecii. Similarly, the immunosuppression from drugs used to suppress rejection in transplantation resulted in infections labeled “opportunistic.” All of these instances, from recognizable, overt immunologic compromise, strongly suggest a role for genetics in increasing or decreasing the susceptibility of a host to an infectious organism. Immunity is a spectrum Not all genetic errors affect every individual with the error – a genetic finding termed incomplete penetrance (complete penetrance affects all individuals with the error). The presence of a BRCA (BReast CAncer) gene mutation reduces tumor suppression elevating the risk of breast and ovarian cancer in those with the mutation. Women with a BRCA1 mutation have a penetrance, a clinical manifestation, of 55 to 72%; those with BRCA2 have a penetrance of 45 to 69%. Some inborn errors occur in cytokines; the small protein foot soldiers invoked in immunity’s inflammatory response. Job’s Syndrome, a rare syndrome involving an error in the interleukin cytokine, results in recurrent skin staph infections. [1] Our immunologic responses are not always correct, and we may develop antibodies to ourselves, termed autoantibodies. The presence of autoantibodies may mimic inborn errors in cytokines by reducing the numbers and effectiveness of the normal cytokines, creating an “autoimmune phenocopy” of a disease. Antibodies to one of the interferons (IFN-α), another of the cytokines involved in our immune defense against viruses, is present in about 1% of adults under age 65 but increase to 4 to 7% in older populations. In a study of 3,595 hospitalized patients with “severe” COVID, autoantibodies to IFN-α were found in 13.6% and were present in 18% of the patients who died. In a new study reported in Nature, the same research group identified a variant of the HLA gene that confers a more robust immunity to COVID. In their study, 13,000 individuals in a donor registry, whose genes had been characterized were found to be positive for COVID. But 10% of those individuals were symptom-free. Roughly 20% of these symptom-free individuals had a specific mutation of their HLA-B gene that made them “especially potent at clearing SARS-CoV-2.” And when that mutation, which has an incidence of roughly 10% in those with European ancestry, is homozygous (coming from both mother and father), it increases the likelihood of remaining asymptomatic in the presence of a positive COVID test 8-fold. A new paradigm “It is, admittedly, difficult to measure the weights of causal factors, and comparing the respective contributions of the germ and host theories is intellectually challenging.” It is the nature of scientific knowledge to build upon the work already done. The development of the germ theory as the explanation of infection has served us well, but it was developed before we had knowledge of immunity, let alone an immune system. For all its explanatory power, the germ theory could not incorporate what Donald Rumsfeld characterized as the “unknown unknowns.” Our understanding
BUCKHANNON, W.Va. (WV News) — St. Joseph’s Hospital and the Rotary Club of Buckhannon-Upshur will hold a blood screening this Saturday at the hospital. Basic blood profile tests will be offered at $35, with additional testing for thyroid for $5, hemoglobin A1C for $15, colon cancer screening for $5 and prostate testing for $20. An additional test for the hepatitis C antibody will be offered for $20.
Doxycycline is an antibiotic in the tetracycline family used to treat acute bacterial sinus infections in people allergic to penicillin. It is also commonly used to treat acne, skin infections like cellulitis, and some sexually transmitted infections (STIs). Doxycycline is sometimes prescribed as an alternative to amoxicillin, another antibiotic used for sinus infections, in people allergic to penicillin-type antibiotics. This article will discuss doxycycline’s role as an antibiotic in treating sinus infections, how it works, and what to expect when taking doxycycline for a sinus infection. Getty Images / WLADIMIR BULGAR/SCIENCE PHOTO LIBRARY How Does Doxycycline Work for a Sinus Infection? Doxycycline blocks bacteria from producing proteins needed to replicate, thereby preventing bacteria from multiplying further. Doxycycline does not kill bacteria; it is considered bacteriostatic, meaning that it suppresses the growth of bacteria. Doxycycline and other antibiotics only work for bacterial sinus infections, though. They will not treat viral infections. How to Take Doxycycline for a Sinus Infection Doxycycline for sinusitis is usually prescribed as 100 milligrams (mg) twice daily for five to seven days. Alternatively, it can be taken at 200 milligrams once a day. Some formulations of doxycycline are best taken on an empty stomach, while others can be taken with or without food. Ask your pharmacist about the specific formulation you are receiving at the pharmacy. If taking doxycycline irritates your stomach, you can try taking it with food or milk to prevent this. Be sure to swallow the capsule or tablet with a large amount of water to ensure that it does not remain in the esophagus, where it could cause irritation. How Long Will Doxycycline Take to Work? Symptoms of acute sinusitis should begin to improve three to five days after starting doxycycline. To clear the infection, take doxycycline for the entire prescribed duration, usually five to seven days. It’s important to continue to take your medication even if you begin to feel better. Stopping your antibiotic regimen early can contribute to antibiotic resistance, and your infection could return. What Side Effects Should I Expect? Like other antibiotics, doxycycline can sometimes cause side effects. However, it is generally considered well tolerated among most people. Side effects of doxycycline may include: Photosensitivity: Doxycycline can make your skin more sensitive to the sun. Avoid prolonged sun exposure, and wear sunscreen and protective clothing to cover your skin in the sun while taking this antibiotic. Diarrhea: Diarrhea is a common side effect of antibiotics that usually clears once antibiotics are finished. Call your healthcare provider if the diarrhea is severe, does not stop, or is bloody. Other gastrointestinal-related issues, like stomach upset and nausea/vomiting Serious side effects of doxycycline may include: Severe allergic skin reaction: Doxycycline can sometimes cause skin reactions that can progress to severe and life-threatening. If you notice a sudden allergic skin reaction, stop taking doxycycline and seek care from a healthcare provider immediately. C. diff diarrhea: C. difficile diarrhea can occur up to two months after taking antibiotics. See a healthcare provider for evaluation if you experience large amounts of watery diarrhea or bloody diarrhea. Intracranial hypertension (pseudotumor cerebri): Doxycycline has been associated with an increase in intracranial pressure. Symptoms include headache, blurred vision, double vision, or vision loss. If visual disturbance occurs while taking doxycycline, seek a prompt eye evaluation. Precautions Doxycycline should not be taken during pregnancy, as it can harm a fetus. Because doxycycline can cause permanent tooth discoloration in developing teeth, it should not be used in children 8 years and younger unless the benefits outweigh the risk (e.g., treatment of anthrax, Rocky Mountain spotted fever). Alternative Treatments for a Sinus Infection The usual first-line antibiotic chosen for treating a bacterial sinus infection in people who are not allergic to penicillin is Amoxil (amoxicillin) or Augmentin (amoxicillin-clavulanate). The other antibiotic option besides doxycycline for people allergic to penicillin is a respiratory fluoroquinolone such as levofloxacin or Avelox (moxifloxacin). Over-the-counter (OTC) products can help with symptomatic relief. These can include: Summary Doxycycline is a tetracycline antibiotic prescribed for acute bacterial sinusitis. It is usually the treatment of choice for people who cannot take penicillin. It’s typically prescribed for five to seven days and is tolerated with minimal side effects by most people. You should start to feel better within three to five days of starting doxycycline; if you don’t feel better or your symptoms worsen, this could mean a virus or a resistant bacteria cause your sinus infection. You should return to a healthcare provider for reevaluation. Frequently Asked Questions Doxycycline is similarly effective to amoxicillin for treating a sinus infection. Amoxicillin is usually chosen in people who do not have an allergy to penicillin, while doxycycline is used in people with a history of penicillin allergy. If you have no improvement in symptoms after taking doxycycline for three to five days, contact your healthcare provider. Potential causes for non-response include sinusitis caused by a virus or resistant bacteria. You might need a different treatment. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. By Carrie Yuan, PharmD Carrie Yuan PharmD is a clinical pharmacist with expertise in chronic disease medication management for conditions encountered in primary care. Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error
In 2010, she auditioned for season 9 of “American Idol” and made it through Hollywood Week, but her time on the show was cut short after she didn’t reach the top 24. Following “American Idol,” she began posting videos of herself performing acoustic versions of songs on YouTube, and by 2013 she was signed to Capitol Records.
First two deaths in 2023 from dengue infection in Singapore; number of cases, clusters decline
SINGAPORE: Two people died of dengue infection in Singapore from April to June this year, marking the first deaths from local dengue infection in 2023, the National Environment Agency (NEA) said in its second-quarter update on Tuesday (Jul 25). According to NEA data as of December 2022, there were a total of 19 deaths from dengue infection in Singapore last year. The number of dengue cases and clusters have decreased as compared to the first quarter of 2023. There were 1,989 cases of infection reported from April to June this year, a decrease of 15.7 per cent from the previous quarter of January to March. NEA also identified 213 clusters from April to June, 170 of which were closed in the same period. The number of identified clusters fell by about 34 per cent, as compared to the previous quarter, it added. But during the same period, the number of mosquito breeding habitats detected went up by about 15 per cent compared to the previous quarter, totalling about 5,300. NEA said the top five breeding habitats in homes for the second quarter of 2023 include domestic containers such as pails, flower pot plates and trays, ornamental containers like vases, canvas or plastic sheets and refuse bins placed outside landed houses. It added the top five breeding habitats in public areas include covered parameter drains, discarded receptacles, gully traps, scupper drains at housing estates and covered parking drains.
The upcoming blood drive for the Senoia area has been rescheduled by the American Red Cross. Please note that instead of the blood drive being held on August 7th from 1-5 p.m., the drive will be on Monday, August 14th, and will go from 3-7 p.m. The August 14th blood drive is still scheduled at the Senoia United Methodist Church. This blood drive is co-sponsored by the local church and the Optimist Club of Senoia. If you are unable to give, you are encouraged to notify others who may be able to donate. One blood donation can help save up to three lives. The “famous” grilled cheese sandwiches are planned to be served again at the upcoming blood drive. This may especially help some of the donors who may want to give blood around the evening dinner time. As a reminder, the American Red Cross has made some changes that should bring in more donors. The organization announced an eligibility change that results in allowing some people to give blood who previously could not do so. In alignment with new FDA guidelines, the American Red Cross has updated its donor eligibility for variant Creutzfeldt-Jakob Disease (vCJD) related to mad cow disease. The Red Cross has eliminated the deferral of donors who spent time in the UK, Ireland or France from 1980 to 2001, who were previously considered to have geographic risk of possible exposure to vCJD. The Red Cross has also eliminated the deferral for individuals who received a blood transfusion from certain European countries from 1980 to present. Those who have questions about their donor record can contact the Red Cross Donor and Client Support Center at 1-866-236-3276. You are encouraged to make an appointment for the upcoming blood drive either by signing up online (http://www.redcrossblood.org/give) or by calling 1-800-RED CROSS (1-800-733-2767). NOTE: If the appointment schedule is full, walk-ins may not be able to donate. The Senoia United Methodist Church is in the historic district of Senoia and is located at 229 Bridge Street. It is at the intersection of Seavy and Bridge Streets. For those not familiar with the area, you can turn east at the downtown intersection of Main Street and Seavy Street, and go past Matt’s Smalltown Pizza and the Veranda Bed & Breakfast towards the Seavy Street City Park or State Highway 85. The church is on the right – only about 2 blocks east of Main Street. The need is constant. The gratification is instant. Give Blood. ™ These blood drives are normally held on the first Monday of every three months. The next one is planned for November 6, 2023. Please mark your calendar. If you would like to learn how you can help in this or another worthwhile project sponsored by the Senoia Optimist Club, please email the club at [email protected]. or visit its Facebook page (“Senoia Optimist Club”). If you would like more information about the Senoia United Methodist Church, please visit its web site at http://senoiaumc.org/ or call the church office at 770-599-3245.
<!– –> The law goes into force immediately. In a major blow to the LGBTQUIA+ community, Russian President Vladimir Putin on July 24 signed a law that bans people from officially or medically changing their gender, The Moscow Times reported. The bill, which was approved unanimously by both houses of parliament, bans any “medical interventions aimed at changing the sex of a person,” as well as changing one’s gender in official documents and public records. This also includes taking hormonal therapy or seeking surgery to change one’s gender. The law further bars transgender people from becoming adoptive parents and annuls marriages in which one person has changed gender. Such treatment will now be allowed only in the case of “congenital physiological anomalies of sex formation in children.” The law goes into force immediately. Lawmakers defended the law saying it aimed to protest Russia against “Western anti-family ideology”, and described gender transitioning as “pure satanism”. Upset at the news, LGBT activists have warned that the law will lead to a further increase in already high rates of suicide and suicide attempts among transgender people, as well as encourage an underground market for surgeries and medications. “The way how these people see their future is collapsing,” Yan Dvorkin, the head of Center-T, a group that helps transgender and non-binary people in Russia, said in an interview with The Moscow Times this month. Same-sex marriage was banned in Russia in 2020 and last year, Russia passed a law banning public displays and media portrayals of non-heterosexual identities. Earlier, a health ministry order said Russian clinics would be staffed with sexologists to help patients “overcome” homosexuality and various sexual “mental disorders”, Reuters reported. Featured Video Of The Day ‘Harmanpreet Kaur Should Be Banned For Her Behaviour’: Anish Sajan
Alfa Lafleur, APRN Nurses play a crucial role in managing symptoms experienced by patients with myeloproliferative neoplasms (MPNs) — a group of blood cancers that cause the bone marrow to overproduce red or white blood cells or platelets. “MPNs are rare, and the nurse/nurse practitioner [must] take the time to listen to the patients and educate them about symptom management,” Alfa Lafleur, APRN, from Florida Cancer Specialists and Research Institute Trinity Cancer Center in Trinity, Florida, told Oncology Nursing News®. Even though the MPN category includes a range of diseases such as myelofibrosis, essential thrombocythemia, and polycythemia vera, patients with MPNs experience several common symptoms. Lafleur said she likes to think of those symptoms in categories. First, Lafleur explained, there are the inflammation-related symptoms including weight loss, night sweats, fever, fatigue and a general feeling of unwellness. Then, there are the microvascular-related symptoms related to dysregulation of the JAK2 pathway, which can cause numbness in the hands and feet as well as headaches, vision changes and a painful rash. There are also symptoms related to the enlargement of the patient’s spleen, including fullness, pain and discomfort in the upper left quadrant of the abdomen. As MPN symptoms typically intensify over time, with patients potentially experiencing long asymptomatic periods, the symptom identification and management work of a nurse is of particular importance. “The nurse remains vigilant in assessing for symptoms as early identification that the disease may be worsening or transforming (which) can result in improved patient outcomes,” Lafleur said. It’s also important for patients to keep tabs on their symptoms, as the MPN Research Foundation explains on its website. “Because symptoms can vary significantly among MPN patients, it is important to track changes in symptoms and their severity between doctor visits,” the foundation states. “Keep current on the latest MPN research updates and speak to your doctor about how changes in your symptoms may call for a change in treatment.” Resources are available for both patients and providers. Lafleur cited the MPN Research Foundation’s education for providers and patient support hotlines staffed by counselors who can in turn provide emotional support and assistance in locating additional resources and support groups. Additionally, Voices of MPN, she said, “has a phenomenal app that helps the patient to track their symptoms, educates on the disease process and offers other resources and support to the patient.” Patients with MPNs, Lafleur noted, can live with their cancer for years as they undergo different treatments that are each associated with side effects and symptoms — an experience that, she said, “can be really frustrating and upsetting” — and can be accompanied by fear of MPNs’ potential transformation into more aggressive forms of cancer such as leukemia or the risk of experiencing amyocardial infarction or cerebral vascular accident, or CVA, also known as a stroke. Lafleur has some straightforward guidance for patients: “My best advice to patients is to remind them that they are not alone in this disease,” she said. “No symptom is too small to bring to the attention of your nurse who is more than willing to assist with the physical and mental challenges that come.” Reference MPN Research Foundation. Accessed July 25, 2023. https://www.mpnresearchfoundation.org/